[Glenys Harrington]

Was this co-sponsored by the college?

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

H: +61 3 96902216

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

Of Michael Wishart
Immunisation Ideas Set to Increase Awareness

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[Glenys Harrington]

Hi Jennifer,

Im not sure which linen cutes (new or old) you are referring to but here is
what I know:

The new state of the art linen (and waste) chutes based on vacuum technology
look sound from an infection control perspective in that they often have the
following features:

*Air in the system is filtered before being discharged into the
environment
*Air and any odour in the system is prevented from entering the
ward/department areas by:

*airlock
*the vacuum created in the pipe network is under negative pressure

*The interlocking computer controls
*Network of pipes that can be cleaned and sanitised
*Separate transport pipe networks for waste and linen
*At the terminal station/central collection area waste is collected
into a fully enclosed compactor/container
*The system can be modified to meet varying periods of hospital
activity/demand

Such systems have been installed in hospital in other countries and are
supported by current guidelines (i.e. The USA 2010 edition of the FGI
Guidelines for Design and Construction of Health Care Facilities)

Here are some links with images and additional information:

http://www.envacgroup.com/

http://en.wikipedia.org/wiki/Automated_Vacuum_Collection

http://www.prweb.com/releases/2013/5/prweb10701601.htm

http://www.youtube.com/watch?vHgIs1dJ8QJI

Historically waste and/or linen chutes in Australia hospitals have been were
gravity systems. Since the late 90s such systems have not been recommended
for the following reasons:

a) Fire risks

See links to the fire training videos used in hospital settings

o Hospitals dont burn down!

Made by film Australia in 1997 – based on a scenario where a patient
disposes of a lighted cigarette down a laundry chute on the 8th floor of the
hospital

*http://www.youtube.com/watch?vYXaqN5pCl3Q

o Hartford hospital fire 1961

*Based on a true story where a patient disposes of a cigarette into a
laundry/waste chute on the 8th floor of the hospital
*http://keyeslifesafety.com/tag/hospital-fires/

b) Occupational Health and Safety risks relating to:

i.
Lifting linen and waste bags

ii.
Exposure to blood or body fluids from leaking or split waste bags

Where I previously worked gravity linen and waste chutes, which had been in
place since 1975, were decommissioned in the late 90s due to Occupational
Health and Safety issues including the following:

*Linen bags were too heavy to lift into the linen chute inlet
*Linen bags became stuck in the linen chute
*Waste bags were splitting in the waste chute and on impact in the
terminal collection container resulting in spillage of blood and/or body
fluids
*The waste chute was not able to be adequately cleaned following a
spill in the chute

Some Australian infection control and other healthcare personnel will be
familiar with gravity chute systems (those working in the 70s, 80s &
90s) however many may not be aware of automated waste and linen collection
system which are based on vacuum technology.

Australian Standards Handbook (HB) 260- 2003

HB 260-2003 was first published in March 2003. As outlined in the forward of
the handbook the aim was to provide information that would assist in the
reduction of the risk of transmission of infectious diseases and multidrug
resistant organisms.

Since March 2003 there has not been a periodic review of the handbook or the
release of new standards or amendments in the intervening years.

The handbook states that chutes (linen and waste) can propel airborne
contaminates throughout the facility and that chutes should not be
incorporated in design features for the management or transfer of waste or
linen in healthcare facilities.

The comment and recommendations are not referenced and handbook only
includes a bibliography.

The comment in relation to propelling airborne contaminates throughout the
facility may have come from the Healthcare Infection Control Practices
Advisory Committee (HICPAC), Draft guidelines for environmental infection
control in healthcare facilities, 2001 which is included in the
bibliography.

On review of the final version of these guidelines which was published in
20041 it states the following in relation to laundry chutes:

Contaminated textiles and fabrics in bags can be transported by cart or
chute. Laundry chutes require proper design, maintenance, and use, because
the piston-like action of a laundry bag traveling in the chute can propel
airborne microbial contaminants throughout the facility. Laundry chutes
should be maintained under negative air pressure to prevent the spread of
microorganisms from floor to floor. Loose, contaminated pieces of laundry
should not be tossed into chutes, and laundry bags should be closed or
otherwise secured to prevent the contents from falling out into the chute.

The main references for statement relating to airborne microbial
contaminants2, 3 were published in 1964 and 1965.

In the early 60s waste and linen collection system based on vacuum
technology were in their initial stages of development and use. In addition
the references also pre-date many hospital vacuum system instillations that
have occurred in subsequent years.

Given the date of HB260-2003 and the references in the CDC HICPAC 2004
guidelines it is likely that such comments and recommendations relate to
gravity chute systems not systems based on vacuum technology. Hence HB
260-2003 may not be current.

I have included the references below:

Reference

1.Sehulster LM, et al. Guidelines for environmental infection control
in health-care facilities. Recommendations from the US department of Health
and Human Services Centers for Disease Control and Prevention (CDC) and the
Healthcare Infection Control Practices Advisory Committee (HICPAC). Chicago
IL; American Society for Healthcare Engineering/American Hospital
Association; 2004)

2.Hughes HG. Chutes in hospitals. Can Hosp 1964; 41:567

3.Michaelsen GS. Designing linen chutes to reduce spread of infectious
organisms. Hospitals JAHA 1965; 39 (3):1169).

Regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

H: +61 3 96902216

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

Of Cath Wade
chutes in hospitals as infection control issue

Chutes are not recommended as per Australian Standards HB 260-2003: Hospital
Acquired Infections Engineering down the risks. Section 3.2 part (o)

The CDC Guidelines for Environmental Infection Control in Health-Care
Facilities also has information regarding laundry chutes.

Both documents contain similar information regarding the spread of airborne
contaminants from laundry chutes. Special design considerations must be
taken into account if used e.g. negative pressure.

There are also problems with cleaning it is very difficult to clean chute.

Regards

Cath Wade

Director

Healthcare & Infection Prevention

Of Tozer, Jennifer (Health)
control issue

Can any of the ACIPC members please provide me with information around
laundry chutes in the health care setting around issues from an infection
control perspective . Also I would be very grateful if anyone could direct
me towards literature around this topic of: laundry chutes and if they are
deemed an infection control issue or not.

Thank you for your assistance

Jennifer K Tozer

BArts Anthro,RN,MHN,IC cert

Infection Prevention & Control Coordinator

Central and Northern Adelaide Local Health Networks

CALHN – MHS [Glenside Campus]

NALHN – MHS [Oakden and James Nash House Campuses]

Telephone (08) 7425 6237 Facsimile (08) 7425 6208 Mobile 0423 782
171

Infection Prevention and Control is Everybodys Business.

email jennifer.tozer@health.sa.gov.au

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[Glenys Harrington]

Hi Irene,

How complex an individual finds the NHSN definitions depends on; a) how
often they are using them, b) how well they have been trained (including
competency assessment) in the standardised application of the definitions
and c) quality checks that need to be in place before reporting an
infection.

The aim of surveillance for surveillance purposes (i.e. not clinical
management) is to standardise the application of the surveillance methods
and definitions so we are comparing apples with apples either over time
internally or externally

(understanding the limitations of inter-hospital comparisons and
benchmarking).

In NHSN surveillance specific sites are assigned to organ space to further
identify the location of the infection. This may not be of particular
relevance to micro, ID, IC however, it will be of interest to
surgeons/surgical registrars who for the purpose of internal audits/death
audits, registries etc may classify infections to an anatomical location in
addition to other criteria.

Given the extensive use of the NHSN definitions worldwide we should leave
any modifications/changes to CDC (who have the funds) and where we have
concerns focus on training or retraining those collecting the surveillance
data in the standardised application of the surveillance methods and
definitions.

This approach has worked well for infection control teams/infectious
diseases staff who I have trained in NHSN surveillance methods/application
of the definitions and was in a setting where the surveillance data was
utilised for research studies.

No surveillance method definitions will identify 100% of infections – the
definitions will miss some infections and on occasions will over call some
infections. As long as we are all doing the same thing (strict application
of each definition) this should not be an issue in terms of why we are
collecting the data timely feedback to relevant clinical and executive
management staff and measuring and monitoring the impact of evidence based
interventions that are implemented to improve patients outcomes.

Regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

H: +61 3 96902216

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

Of Wilkinson, Irene (Health)
site infection definition for sternotomy infections

Hi Glenys,

Personally I believe the NHSN definitions are overly complex. I can
understand the reason for distinguishing superficial infections from
deep/organ space, but really what is the purpose of distinguishing deep from
organ space? The likely causes/sources of infection and hence preventive
measures would be similar.

Regards,

Irene

Irene Wilkinson

Manager, Infection Control Service

SA Health

Irene.wilkinson@health.sa.gov.au

Of Glenys Harrington
for sternotomy infections

Hi John,

While there is no muscle there is fascia and if involved you would proceed
with using the deep definition to see if you meet the other criteria. From
your description it seems in your cases you would meet b plus 1 signs of
infection confirming it was a deep infection.

The definition seems fairly straight forward to me and I have found it very
easy to use over the years. It is a definition for surveillance purposes
not clinical management.

By definition an organ space infection does not include the wound, hence
infection deep to the deep fascia a deep (or organ space infection) is
not the correct application of the organ space definition.

Vac dressings can be used on lots of wounds including superficial sternal
wounds (see below). The foam is cut and contoured to fit the size of the
tissue defect, and covered with an adhesive drape and connected through the
evacuation tube to the vacuum pump. There is no exposure of the wound
bed/surface using these devices.

From memory there is usually an percutaneous suture in closure of a sternal
wound.

Bapat V et al. Experience with Vacuum-assisted closure
of sternal wound infections following cardiac surgery and evaluation of
chronic complications associated with its use.
J Card Surg. 2008
May-Jun;23(3):227-33Department of Cardiothoracic Surgery, St Thomas’
Hospital, London, UK. vnbapat@yahoo.com

Dezfuli B et al, Treatment of Sternal Wound Infection With Vacuum-assisted
Closure. Wounds. 2013;25(2)

Regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

H: +61 3 96902216

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

Of John Ferguson
site infection definition for sternotomy infections

Thanks Glenys

However, there is no muscle overlaying the sternum and the deep fascia is
just above the periosteum of the sternum.

For the most part there is just skin and subcut tissue in front of the
sternum. These tissues overlying the sternum are very thin in most people.

And so it is nonsensical to distinguish superficial from deep based on this
definition in my view

I don’t think that most surgeons put a closure layer beneath the skin once
the sternum is wired- it is impossible. Effectively, then, opening or
dehiscence of the incision will expose the fascia. Similarly, I cannot see
that application of a vac can be done to a ‘superficial’ wound as the fascia
will be exposed in these sort of wounds.

I could cope if the definition specified in this case that infection deep to
the deep fascia a deep (or organ space infection); however that is not
what it says.

We are long overdue for a better NHSN SSI definition., esp for sternal
wounds

John

Dr John Ferguson

Director, Infection Prevention & Control, Hunter New England Health
Tel 61 2 4921 4444 | Fax 61 2 4921 4440 | Mob +61 428 885 573 |
john.ferguson@hnehealth.nsw.gov.au | http://www.hicsiganz.org

http://www.health.nsw.gov.au/images/communications/e-signatures/images/NSW-H
ealth-Hunter-New-England-LHD.jpg

Of Glenys Harrington
for sternotomy infections

Hi John,

Whether or not these wounds are superficial or deep depends on the first
part of the definition as to what tissue is involved. This question has to
be answered before progressing to the rest of the definition.

Superficial – Infection occurs within 30 days after any NHSN operative
procedure and involves only skin and subcutaneous tissue of the incision

Deep – Infection occurs within 30 or 90 days after the NHSN operative
procedure and involves deep soft tissues of the incision (e.g., fascial and
muscle layers)

If only skin and subcutaneous tissue are involved it meets the superficial
definition as from your description c below is met and, Im assuming that
the patient had at least 1 of the sign or symptom below.

patient has at least 1 of the following:

a. purulent drainage from the superficial incision

b. organsims isolated from an aseptically-obtained culture of fluid or
tissue from the superficial incision

c. superficial incision that is deliberately opened by a surgeon and is
culture-positive or not cultured

and

patient has at least one of the following signs or symptoms of infection:
pain or tenderness; localized swelling; redness; or heat. A culture negative
finding does not meet this criterion

d. diagnosis of superficial incisional SSI by the surgeon or attending
physician

If deep soft tissues (e.g., fascial and muscle layers) are involved it will
meet the deep definition as from your description b below has been met and
Im assuming that the patient has at least 1 of the sign or symptom below.

patient has at least one of the following:

a. purulent drainage from the deep incision

b. a deep incision that spontaneously dehisces or is deliberately opened by
a surgeon and is culture- positive or not cultured

and

patient has at least one of the following signs or symptoms: fever (>38C);
localized pain or tenderness. A culture-negative finding does not meet this
criterion.

c. an abscess or other evidence of infection involving the deep incision is
found on direct examination, during invasive procedure, or by
histopathologic examination or imaging test.

d. diagnosis of a deep incisional SSI by a surgeon or attending physician.

Hence in the first instance you need to know what level the surgeon has
opened these wounds too as VACs can be used on superficial or deep would
infections.

Just on organ space infections these wounds as described would not be
considered an organ space infection as such infections exclude the skin
incision, fascia, or muscle layers, that is opened or manipulated during the
operative procedure (i.e. the incisional wound is not involved at all). In
this surgical setting an organ space infection would be something like
osteomyelitis of the sternum without surgical incision/wound involvement.

I use a definition checklist (i.e. it either meets or does not meet the
criteria) when training staff in the interpretation of the definitions for
surveillance purposes.

Can send a copy if you like.

Regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

H: +61 3 96902216

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

Of John Ferguson
infection definition for sternotomy infections

Dear All

Would appreciate advice on interpretation of the definition (below)

In two sternotomy cases, there has been prolonged ooze post op (several
days) and the surgeon concerned has opened the wound on the ward and then
instituted vac dressings

The cases required prolonged nursing management but did not come to formal
debridement or removal of sternal wires etc. CT scans did not show
retrosternal collections (ie not organ space infection)

In my view, this constitutes a ‘deep’ wound infection. What would others
say?

Our other surgeons would have usually taken such cases to theatre and
performed open debridement

in one case the culture grew Serratia

in the other, culture was no growth; in that case, the determination rests
then on whether we had ‘purulent drainage’ observed from the ‘deep incision’

it does beg the question as to how one gauges from what level the drainage
is coming fron and also whether one should use an objective measure for what
is purulent etc!

criterion b under superficial is also problematic – how does one ever get
‘aseptically-obtained’ samples from a superficial incision? wound swabs
presumably not ok but I would guess are used

Would be very interested to know of how people teach surveillance staff to
apply the NHSN definition, esp for sternotomies , where essentially the
superficial wound is extremely close to the deep sternal structure , and
also for prosthetic joints where similar problems of distinguishing the
depth of infection arise

thanks

John

Dr John Ferguson
Director, Infection Prevention & Control, Hunter New England Health

Locked Bag 1, Newcastle Mail Centre, NSW 2310
Tel 61 2 4921 4444 | Fax 61 2 4921 4440 | Mob +61 428 885 573 |
john.ferguson@hnehealth.nsw.gov.au | http://www.hicsiganz.org

http://www.health.nsw.gov.au/images/communications/e-signatures/images/NSW-H
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[Glenys Harrington]

Hi John,

While there is no muscle there is fascia and if involved you would proceed
with using the deep definition to see if you meet the other criteria. From
your description it seems in your cases you would meet b plus 1 signs of
infection confirming it was a deep infection.

The definition seems fairly straight forward to me and I have found it very
easy to use over the years. It is a definition for surveillance purposes
not clinical management.

By definition an organ space infection does not include the wound, hence
infection deep to the deep fascia a deep (or organ space infection) is
not the correct application of the organ space definition.

Vac dressings can be used on lots of wounds including superficial sternal
wounds (see below). The foam is cut and contoured to fit the size of the
tissue defect, and covered with an adhesive drape and connected through the
evacuation tube to the vacuum pump. There is no exposure of the wound
bed/surface using these devices.

From memory there is usually an percutaneous suture in closure of a sternal
wound.

Bapat V et al. Experience with Vacuum-assisted closure
of sternal wound infections following cardiac surgery and evaluation of
chronic complications associated with its use.
J Card Surg. 2008
May-Jun;23(3):227-33Department of Cardiothoracic Surgery, St Thomas’
Hospital, London, UK. vnbapat@yahoo.com

Dezfuli B et al, Treatment of Sternal Wound Infection With Vacuum-assisted
Closure. Wounds. 2013;25(2)

Regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

H: +61 3 96902216

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

Of John Ferguson
site infection definition for sternotomy infections

Thanks Glenys

However, there is no muscle overlaying the sternum and the deep fascia is
just above the periosteum of the sternum.

For the most part there is just skin and subcut tissue in front of the
sternum. These tissues overlying the sternum are very thin in most people.

And so it is nonsensical to distinguish superficial from deep based on this
definition in my view

I don’t think that most surgeons put a closure layer beneath the skin once
the sternum is wired- it is impossible. Effectively, then, opening or
dehiscence of the incision will expose the fascia. Similarly, I cannot see
that application of a vac can be done to a ‘superficial’ wound as the fascia
will be exposed in these sort of wounds.

I could cope if the definition specified in this case that infection deep to
the deep fascia a deep (or organ space infection); however that is not
what it says.

We are long overdue for a better NHSN SSI definition., esp for sternal
wounds

John

Dr John Ferguson

Director, Infection Prevention & Control, Hunter New England Health
Tel 61 2 4921 4444 | Fax 61 2 4921 4440 | Mob +61 428 885 573 |
john.ferguson@hnehealth.nsw.gov.au | http://www.hicsiganz.org

http://www.health.nsw.gov.au/images/communications/e-signatures/images/NSW-H
ealth-Hunter-New-England-LHD.jpg

Of Glenys Harrington
for sternotomy infections

Hi John,

Whether or not these wounds are superficial or deep depends on the first
part of the definition as to what tissue is involved. This question has to
be answered before progressing to the rest of the definition.

Superficial – Infection occurs within 30 days after any NHSN operative
procedure and involves only skin and subcutaneous tissue of the incision

Deep – Infection occurs within 30 or 90 days after the NHSN operative
procedure and involves deep soft tissues of the incision (e.g., fascial and
muscle layers)

If only skin and subcutaneous tissue are involved it meets the superficial
definition as from your description c below is met and, Im assuming that
the patient had at least 1 of the sign or symptom below.

patient has at least 1 of the following:

a. purulent drainage from the superficial incision

b. organsims isolated from an aseptically-obtained culture of fluid or
tissue from the superficial incision

c. superficial incision that is deliberately opened by a surgeon and is
culture-positive or not cultured

and

patient has at least one of the following signs or symptoms of infection:
pain or tenderness; localized swelling; redness; or heat. A culture negative
finding does not meet this criterion

d. diagnosis of superficial incisional SSI by the surgeon or attending
physician

If deep soft tissues (e.g., fascial and muscle layers) are involved it will
meet the deep definition as from your description b below has been met and
Im assuming that the patient has at least 1 of the sign or symptom below.

patient has at least one of the following:

a. purulent drainage from the deep incision

b. a deep incision that spontaneously dehisces or is deliberately opened by
a surgeon and is culture- positive or not cultured

and

patient has at least one of the following signs or symptoms: fever (>38C);
localized pain or tenderness. A culture-negative finding does not meet this
criterion.

c. an abscess or other evidence of infection involving the deep incision is
found on direct examination, during invasive procedure, or by
histopathologic examination or imaging test.

d. diagnosis of a deep incisional SSI by a surgeon or attending physician.

Hence in the first instance you need to know what level the surgeon has
opened these wounds too as VACs can be used on superficial or deep would
infections.

Just on organ space infections these wounds as described would not be
considered an organ space infection as such infections exclude the skin
incision, fascia, or muscle layers, that is opened or manipulated during the
operative procedure (i.e. the incisional wound is not involved at all). In
this surgical setting an organ space infection would be something like
osteomyelitis of the sternum without surgical incision/wound involvement.

I use a definition checklist (i.e. it either meets or does not meet the
criteria) when training staff in the interpretation of the definitions for
surveillance purposes.

Can send a copy if you like.

Regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

H: +61 3 96902216

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

Of John Ferguson
infection definition for sternotomy infections

Dear All

Would appreciate advice on interpretation of the definition (below)

In two sternotomy cases, there has been prolonged ooze post op (several
days) and the surgeon concerned has opened the wound on the ward and then
instituted vac dressings

The cases required prolonged nursing management but did not come to formal
debridement or removal of sternal wires etc. CT scans did not show
retrosternal collections (ie not organ space infection)

In my view, this constitutes a ‘deep’ wound infection. What would others
say?

Our other surgeons would have usually taken such cases to theatre and
performed open debridement

in one case the culture grew Serratia

in the other, culture was no growth; in that case, the determination rests
then on whether we had ‘purulent drainage’ observed from the ‘deep incision’

it does beg the question as to how one gauges from what level the drainage
is coming fron and also whether one should use an objective measure for what
is purulent etc!

criterion b under superficial is also problematic – how does one ever get
‘aseptically-obtained’ samples from a superficial incision? wound swabs
presumably not ok but I would guess are used

Would be very interested to know of how people teach surveillance staff to
apply the NHSN definition, esp for sternotomies , where essentially the
superficial wound is extremely close to the deep sternal structure , and
also for prosthetic joints where similar problems of distinguishing the
depth of infection arise

thanks

John

Dr John Ferguson
Director, Infection Prevention & Control, Hunter New England Health

Locked Bag 1, Newcastle Mail Centre, NSW 2310
Tel 61 2 4921 4444 | Fax 61 2 4921 4440 | Mob +61 428 885 573 |
john.ferguson@hnehealth.nsw.gov.au | http://www.hicsiganz.org

http://www.health.nsw.gov.au/images/communications/e-signatures/images/NSW-H
ealth-Hunter-New-England-LHD.jpg

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[Glenys Harrington]

Hi John,

Whether or not these wounds are superficial or deep depends on the first
part of the definition as to what tissue is involved. This question has to
be answered before progressing to the rest of the definition.

Superficial – Infection occurs within 30 days after any NHSN operative
procedure and involves only skin and subcutaneous tissue of the incision

Deep – Infection occurs within 30 or 90 days after the NHSN operative
procedure and involves deep soft tissues of the incision (e.g., fascial and
muscle layers)

If only skin and subcutaneous tissue are involved it meets the superficial
definition as from your description c below is met and, Im assuming that
the patient had at least 1 of the sign or symptom below.

patient has at least 1 of the following:

a. purulent drainage from the superficial incision

b. organsims isolated from an aseptically-obtained culture of fluid or
tissue from the superficial incision

c. superficial incision that is deliberately opened by a surgeon and is
culture-positive or not cultured

and

patient has at least one of the following signs or symptoms of infection:
pain or tenderness; localized swelling; redness; or heat. A culture negative
finding does not meet this criterion

d. diagnosis of superficial incisional SSI by the surgeon or attending
physician

If deep soft tissues (e.g., fascial and muscle layers) are involved it will
meet the deep definition as from your description b below has been met and
Im assuming that the patient has at least 1 of the sign or symptom below.

patient has at least one of the following:

a. purulent drainage from the deep incision

b. a deep incision that spontaneously dehisces or is deliberately opened by
a surgeon and is culture- positive or not cultured

and

patient has at least one of the following signs or symptoms: fever (>38C);
localized pain or tenderness. A culture-negative finding does not meet this
criterion.

c. an abscess or other evidence of infection involving the deep incision is
found on direct examination, during invasive procedure, or by
histopathologic examination or imaging test.

d. diagnosis of a deep incisional SSI by a surgeon or attending physician.

Hence in the first instance you need to know what level the surgeon has
opened these wounds too as VACs can be used on superficial or deep would
infections.

Just on organ space infections these wounds as described would not be
considered an organ space infection as such infections exclude the skin
incision, fascia, or muscle layers, that is opened or manipulated during the
operative procedure (i.e. the incisional wound is not involved at all). In
this surgical setting an organ space infection would be something like
osteomyelitis of the sternum without surgical incision/wound involvement.

I use a definition checklist (i.e. it either meets or does not meet the
criteria) when training staff in the interpretation of the definitions for
surveillance purposes.

Can send a copy if you like.

Regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

H: +61 3 96902216

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

Of John Ferguson
infection definition for sternotomy infections

Dear All

Would appreciate advice on interpretation of the definition (below)

In two sternotomy cases, there has been prolonged ooze post op (several
days) and the surgeon concerned has opened the wound on the ward and then
instituted vac dressings

The cases required prolonged nursing management but did not come to formal
debridement or removal of sternal wires etc. CT scans did not show
retrosternal collections (ie not organ space infection)

In my view, this constitutes a ‘deep’ wound infection. What would others
say?

Our other surgeons would have usually taken such cases to theatre and
performed open debridement

in one case the culture grew Serratia

in the other, culture was no growth; in that case, the determination rests
then on whether we had ‘purulent drainage’ observed from the ‘deep incision’

it does beg the question as to how one gauges from what level the drainage
is coming fron and also whether one should use an objective measure for what
is purulent etc!

criterion b under superficial is also problematic – how does one ever get
‘aseptically-obtained’ samples from a superficial incision? wound swabs
presumably not ok but I would guess are used

Would be very interested to know of how people teach surveillance staff to
apply the NHSN definition, esp for sternotomies , where essentially the
superficial wound is extremely close to the deep sternal structure , and
also for prosthetic joints where similar problems of distinguishing the
depth of infection arise

thanks

John

Dr John Ferguson
Director, Infection Prevention & Control, Hunter New England Health

Locked Bag 1, Newcastle Mail Centre, NSW 2310
Tel 61 2 4921 4444 | Fax 61 2 4921 4440 | Mob +61 428 885 573 |
john.ferguson@hnehealth.nsw.gov.au | http://www.hicsiganz.org

http://www.health.nsw.gov.au/images/communications/e-signatures/images/NSW-H
ealth-Hunter-New-England-LHD.jpg

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[Glenys Harrington]

Dear All,

The risk seen obvious eating may result in hand contamination with mouth
organisms. Combined with suboptimal hand hygiene and/or poor/inadequate
aseptic technique this may lead to a device related infection or a pseudo
infection.

Im sure most patients would prefer not to end up with a Streptococcus mitis
bloodstream infection or bacterial endocarditis as a result of staff eating
in the OR.

Regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

H: +61 3 96902216

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

Of Michael Wishart
anaesthetic bays

Hi JoeAnne

I have always battled to stop this in every hospital I have worked in
(mostly private sector). The main argument is from those anaesthetists who
are doing long cases in a list they claim they cannot take a break! My
argument to them has always been: Do you want to explain to the patients
(and the surgeon!) how they got a muffin [or insert any other food item
here] granuloma in their surgical wound?!?! It is about ensuring we
restrict items from within the operating room that are unnecessary.

Trying to appeal to their risk from having to take their mask off to eat /
drink doesnt work, as many do not even wear a mask!!!

In my mind it is all about appropriate management of their work just like
anyone else. If you can get executive buy-in to support you, you can at
least require compliance, even if these anaesthetists dont believe they are
putting the patients (or themselves) potentially at risk.

Good luck.

Cheers

Michael

Michael Wishart

CNC Infection Control

Holy Spirit Northside Private Hospital

627 Rode Road, Chermside, Qld 4032

t: (07) 3326 3068 | f: (07) 3607 2226

e: Michael.Wishart@hsn.org.au

w:
http://www.holyspiritnorthside.org.au

Please consider the environment before printing this email

Of Joe-Anne Bendall

Good morning

We have been asked by Anaesthetists if they can eat and drink in the
Anaesthetic Bays as this is what they do in private hospitals during
long cases..I am not sure how accurate this information is.

Does any hospital allow this practice to occur and what are the
circumstances for this to occur?

PS It does not occur at this hospital for a number of reasons:

1. Infection control policy requirement

2. Community expectations

3. Workplace Health and Safety

Thanks

Joe-Anne Bendall

Joe-anne Bendall | Clinical Nurse Consultant Infection Prevention and
Control
Sydney Hospital and Sydney Eye Hospital

8 Macquarie St

SYDNEY NSW 2000

|( ph +61 2 9382 7199 |page 22070 via switch 9382 7111| 7 Fax 93827510 |

Mobile 0418984255 | * Joe-anne.Bendall@SESIAHS.HEALTH.NSW.GOV.AU

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[Glenys Harrington]

Dear All,

Further to below the following publication in ICHE discusses this question and may be of interest along with some of the references for this quote taken from the publication.

“For example, in 2 similar prospective cohort studies conducted in the same ICU, cross transmission was found to be important for ESBL-producing K. pneumonia but not for Escherichia coli. Moreover, ESBL producing E. coli are endemic in the community in many countries, whereas this phenomenon is described less often for other species”

The authors also make a very good point in that when assessing the need for contact precautions for multidrug-resistant Enterobacteriaceae that you quantifying the clinical impact of HAIs caused by these organism and ascertain the proportion of newly colonized patients who develop infection.

Publication Details:

When Should Contact Precautions and Active Surveillance Be Used to Manage Patients with Multidrug-Resistant Enterobacteriaceae?

Author(s): Joshua T. Freeman, MBChB, FRCPA; Deborah A. Williamson, MBChB, MRCP; Deverick J. Anderson, MD, MPH

Regards

Glenys

Glenys Harrington
Consultant
Infection Control Consultancy (ICC)

PO Box 5202
Middle Park
Victoria, 3206
Australia
H: +61 3 96902216
M: +61 404 816 434
infexion@ozemail.com.au
ABN 47533508426

—–Original Message—–

Hi Micheal
We risk assess all patient’s with an ESBL. We are less likely to isolate a e-coli ESBL compared to a Klebsiella ESBL. Also I depends on the patient group being cohorted or allocated within. In lower risk environments such as aged care where we have no evidence of cross infection we do not isolate unless the patient has a urinary catheter in situ.
I think using a risk assessment approach is important as it’s impossible to isolate all patient colonised Giulietta Pontivivo| Nurse Manager/CNC| Infection Prevention Management & Staff Health Services| St Vincent’s Health Network | 390 Victoria Street Darlinghurst | NSW 2010
T: 61 2 83823284| F: 61 2 8382 3892| M: 0457 533 452 | E: gpontivivo@stvincents.com.au

with an MRO.
Regards Giulietta

—–Original Message—–

Hi all

Just thought I’d bump this question again, as I didn’t get any responses. Surely someone has an opinion on which gram-negatives need to be managed as MROs?

Thanks
Michael

Michael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
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[Glenys Harrington]

Hi John,

See link to the Victorian DOH “Guidelines for the classification and design
of isolation rooms in health care facilities”

http://www.health.vic.gov.au/infectionprevention/publications/design_isolati
on_rooms.htm

Full PDF at the bottom of the page

As Kevin mentioned in his response dual purpose room are not recommended –
see 2.4 Class A-Alternating pressure (negative/positive pressure) on page 7

“Rooms with reversible airflow mechanisms enabling the room to be either
negative or positive pressure are not recommended.(7) Problems with such
rooms include the difficulty of configuring appropriate airflow for two
fundamentally different purposes (see section 5.4), the risk of operator
error, complex engineering and fail safe mechanisms”

Regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

H: +61 3 96902216

M: +61 404 816 434

infexion@ozemail.com.au

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Of John Ferguson
precaution (pos pressure) room design

Dear Brainstrust

Some time ago, I came across a novel configuration of a single room that
provides for both protective (positive pressure barrier) and isolation
(negative pressure) requirements. Extensive testing was described at the
Hospital Infection Society Conference, Amsterdam 2006. It was specified
under Building Note 4 by
HEFMA but the link no longer works and I’ve been unsuccessful with chasing
down the design. Concept involves an isolation room with a positive pressure
anteroom and exhaust from the ensuite room which is entered from the main
room. The design is relatively fail-safe and does not need to be manually
configured.

I wondered whether anyone has come across this? Has anyone built functioning
dual purpose isolation/barrier rooms? We are building a new paed ICU and we
need both types of room !

thanks

John

http://hicsigwiki.asid.net.au/index.php?title=Built_Environment

Dr John Ferguson
Director, Infection Prevention & Control, Hunter New England Health

Infectious Diseases Physician, Division of Medicine, John Hunter Hospital

Clinical Microbiologist, Hunter Area Pathology, Pathology North

Conjoint Associate Professor, University of Newcastle, Adjunct Professor,
University of New England

Locked Bag 1, Newcastle Mail Centre, NSW 2310
Tel 61 2 4921 4444 | Fax 61 2 4921 4440 | Mob +61 428 885 573 |
john.ferguson@hnehealth.nsw.gov.au | http://www.hicsiganz.org

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[Glenys Harrington]

Dear All,

Many thanks to all those members who sent me a hard copy to this document
and the QLD document/link relating to the above matters.

Your collegiality and assistance very much appreciated.

regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

H: +61 3 96902216

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

Of Glenys Harrington
Guidelines for Storage and Handling of Pre-Sterilized Consumables

Dear All,

Can anyone from NSW assist me with locating the following document which is
listed as a resources in B1.5.8 in the Australian Guidelines for the
Prevention and Control of Infection in Healthcare (2010).

. NSW Health, Health Procurement, Guidelines for Storage and
Handling of Pre-Sterilized Consumables

Many thanks in anticipation

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

H: +61 3 96902216

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

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[Glenys Harrington]

Hi Lyn,

My understanding is that they are too noisy for clinical areas particularly
at night.

Regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

H: +61 3 96902216

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

Of Lyn A. Golden
sinks

Has anybody had any experience with installation of hand dryers (warm
blowing air) in clinical areas?
We are building a new facility, the question has been raised can we install
hand dryers instead of paper towel in clinical areas at the hand washing
sinks?

Does anyone have any thoughts on this?

Lyn

Infection Prevention and Control Manager

Echuca Regional Health
17 Francis Street
Echuca 3564

Helping Everyone To Be And Stay Healthy

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[Glenys Harrington]

Hi Michael,

I’m interested to know how you manage the clearance regime to get the weekly
rectal swabs over a three week period for all your VRE positive patients
over time.

Do you have a computer tracking and readmission and flagging system or is
this tracking done manually?

What if the VRE patient goes home before the 3 weeks is up? I’m guessing
that with the exception of your dialysis patients the average length of stay
of most inpatients is probably only 4-5 days so do you follow up pts after
discharge to complete the clearance regime?

Would be interested to hear from other infection control teams with similar
clearance regimes and those who also have a large accumulated numbers of
VRE positive patients as to how tracking and readmission
flagging/identification occurs.

Regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

Of Michael Wishart

Hi Barbara

In my lovely hospital here we have 80+% single rooms (including 2 in our 15
bed ICU), so isolation of inpatients with VRE is not a problem, and we
isolate all patients with a history of VRE. We do have a ‘clearance’ regime
that involves 3 negative rectal swabs (plus any other infected / colonised
sites) at least 3 months after last positive, on no antibiotic therapy for
at least 2 weeks, and the clearance swabs must be at least a week apart.

Having said all that, in hospitals with limited single rooms I have seen all
sorts of algorithms for isolation of VRE. Some of the thoughts in these
include risk of transmission (high risk patients: those with diarrhoea or
symptomatic infection; high risk areas like dialysis / transplant / oncology
/ ICU) and time since last positive.

There was actually a discussion a while ago (?Ozbug, ?HICSIG) about the
whole value of VRE precaution, since the actual morbidity with VRE infection
is low (even though colonisation rates may be increasing), so there are
varied opinions on this.

Cheers

Michael

Michael Wishart

CNC Infection Control

Holy Spirit Northside Private Hospital

627 Rode Road, Chermside, Qld 4032

t: (07) 3326 3068 | f: (07) 3607 2226

e: Michael.Wishart@hsn.org.au

w:
http://www.holyspiritnorthside.org.au

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Of May, Barbara

Hello,

My managers have asked me to review our current practices of isolating VRE
positive patients. This is mainly due to the limited number of single rooms
within our facility. I am interested to know how you manage patients who
have a positive VRE screen, whether you isolate or not, what risk
assessments you undertake to determine as to whether to isolate or not and
whether you have introduced a yoghurt regime for these patients and how you
then manage these patients.

Thanking you in advance,

Barbara

Barbara May

CNC Infection Control

Hastings Macleay Clinical Network

Ph. 0255242061

Mo. 0402890677

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[Glenys Harrington]

Hi Sue,

My experience with these types of taps:

a) impatient staff noted to contaminate their hands by touching the sensor
repeatedly during hand washing

b) temperature cannot be modified (% cold/warm)

c) hospital engineers did not like them as they had higher maintenance
requirements than elbow taps

regards

Glenys

Glenys Harrington
Consultant
Infection Control Consultancy (ICC)

PO Box 5202
Middle Park
Victoria, 3206
Australia
H: +61 3 96902216
M: +61 404 816 434
infexion@ozemail.com.au
ABN 47533508426

—–Original Message—–
Of Lee, Rosie

Hello

We also had them in our ICU in 2002 (installed without real consultation
with IC) and have had issues with it. An outbreak of MRPA in our ICU
identified the source to be these taps following literature search
indicating the issues as outlined by Sue. This was confirmed by typing.
We did not publish but presented this at the National Conference. We have
had to implement monthly thermal heating & disinfection since.
I don’t support these taps unless there are newer better products which
addresses the issues and you have a good maintenance program in place.
However as already mentioned, this is costly and not monitored effectively.

Regards
Rosie
Rosie Lee
RN. BSc. CICP
Coordinator – Infection Prevention & Management
SMH Service – Royal Perth Hospital

Ph + 61 8 9224 2805 Fax + 61 8 9224 1989
IMPORTANT NOTICE: The contents of this email (including any attachments) may
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If you received this email in error, please advise me by reply email or
telephone —–Original Message—–
Of Tim Spencer

Sue,
We had them in our old ICU before moving into our bigger, new facility.
They failed regularly and were a major inconvenience when not working.
Seriously, consider the normal long handled (elbow-control) taps and
handles.
Power failures are also problematic.
T..

Regards, Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant | Central Venous Access & Parenteral Nutrition
Service Conjoint Lecturer, University of NSW Dept of Intensive Care, Level
2, Clinical Building, Liverpool Hospital, Elizabeth Street, Liverpool, 2170,
NSW, Australia Tel 02 8738 3603 | Fax 02 8738 3551 | Mob +61(0)409 463 428 |
Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au

________________________________

Dear All

Here at the Royal Hobart Hospital we are in the detailed design stage of our
major redevelopment project, and we are currently investigating the pros and
cons of the electronic sensor taps for our clinical hand basins. I have
undertaken a literature search and it appears that some facilities that have
installed the newer sensor taps, as an infection prevention and control
improvement activity, are now removing them and returning to the more
traditional elbow taps.

The literature suggests that the complexity of the internal workings of the
electronic tap and the lower dynamic water flow, could contribute to the
higher level of legionella and other waterborne bacteria found by some
studies.

I am very interested to hear from facilities within Australia, regarding
what type of tap ware has been installed within newly refurbished areas or
new construction projects.

Kind Regards

Sue Draycott

Infection Control Manager

Redevelopment RHH and CCC Services

Southern Tasmania Area Health Service

Level 9, A Block, Royal Hobart Hospital

Liverpool Street

Hobart, 7000

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[Glenys Harrington]

Hi So,

I’m not familiar with the system at the link you provided.

You will need to evaluated each system individually in terms of their
advantages and disadvantages.

The manufacturer or supplier should be able to provide you with information
in relation to any infection control concerns you may have in relation to
disposal of linen or waste via a chute system.

Regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

H: +61 3 96902216

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

Of Sony SO
&/or waste chute

Dear Glenys & Michael,

Thank for your information.

Because we are preparing for hospital renovation, hence we would like to
keep abreast of updated international infection control requirements, with a
view to further reducing infection control hazards caused by transportation
of waste & contaminated linen. My further questions are as follows:

If linen chute &/or waste chute are used, what are the recommended infection
control measures; & whether we would transport clinical waste or infected
linen via respective chutes.

At present, we noted another transportation system for used linen, for
details, please visit MIH system website http://www.mhisystems.com
. The aforesaid system seems
not only reduce infectious risk, but risk of manual handling operation is
also addressed.

Regards,

Sony SO

Nursing Officer, Infection Control Team

Kwong Wah Hospital

HONG KONG SAR,CHINA

Tel:+ 852 3517-2409 Fax: +852 2332-3348 email:sony@ha.org.hk

Please consider the environment before printing this e-mail

Of Glenys Harrington

Hi Sony and Michael,

The only Australian reference to linen and waste chutes is the “2003
Handbook – Hospital acquired infections – Engineering down the risks” which
states the following:

. 3.2(a) Disposal rooms para 2 – “Chutes require particular design
features and will raise ongoing maintenance and cleaning issues. In
addition, chutes can propel airborne contaminants throughout the facility.
Therefore, chutes should not be incorporated in design features for the
management of transport of waste or linen in healthcare facilities”

These standards may be somewhat out of date (i.e. 2003) as new generation
waste and linen chute systems have been introduced into Europe, Asia and the
US for use in residential, industrial, commercial and hospital and nursing
home settings.

In the US the “2010 edition of the FGI “Guidelines for Design and
Construction of Health Care Facilities”, refuse and linen chutes are
permitted and the guideline and states the following:

Refuse chutes

2.1.4 Patient Support Services

2.1-5 General Support Services and Facilities

2.1 – 5.4 Waste Management Facilities

2.1 0 5.4.1.4 Refuse chutes, If provided, these shall meet or exceed the
following standards:

(1) Chutes shall meet the provisions described in NFPA 82

(2) Service openings to chutes shall comply with NFPA 101

(3) Chute discharge into collection rooms shall comply with NFPA 101

(4) The minimum cross-sectional dimension of gravity chutes shall be 2 feet
(60.96 centimetres)

Linen chutes

2.2-5.2.6 – if provided shall meet or exceed the following standards:

2.5 -5.2.6.1 Standards

(1) Service openings to chutes shall comply with NFPA 101

(2) Chutes shall meet the provision described in NFPA 82

(3) Chute discharge into collection rooms shall comply with NFPA 101

2.2-5.2.6.2 Dimensions. The minimum cross-sectional dimensions of gravity
chutes shall be 2 feet

(60.96 centimetres)

The NFPA is the US “National Fire Protection Association”

In addition the USA DRAFT – 2014 edition of the FGI “Guidelines for Design
and Construction of Health Care Facilities” includes guidelines for such
chutes.

The draft 2014 manuscript is available for public comment can be accessed at
the following link: http://www.fgiguidelines.net/comments/draft.php

Regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

H: +61 3 96902216

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

Of Michael Wishart
&/or waste chute

Hi Sony

My understanding is that in Australia, most new hospital buildings, and
indeed those being refurbished, have removed linen and waste chutes due to
fire regulations prohibiting them. So I would not think there are many
hospitals with these kinds of chutes left in this country.

Cheers
Michael Wishart

Michael Wishart

CNC Infection Control

Holy Spirit Northside Private Hospital

627 Rode Road, Chermside, Qld 4032

t: (07) 3326 3068 | f: (07) 3326 3523

e: Michael.Wishart@hsn.org.au

w:
http://www.holyspiritnorthside.org.au

Please consider the environment before printing this email

_____

SO [sony@HA.ORG.HK]

Dear All,

We are preparing our hospital renovation project, hence we would like to
know whether you would use linen chute &/or waste chute.

Your sharing would be a tremendous help.

Regards,

Sony SO

Nursing Officer, Infection Control Team

Kwong Wah Hospital

HONG KONG SAR, CHINA

Tel:+ 852 3517-2409 Fax: +852 2332-3348 email:sony@ha.org.hk

Please consider the environment before printing this e-mail

_____

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[Glenys Harrington]

Hi Sony and Michael,

The only Australian reference to linen and waste chutes is the “2003
Handbook – Hospital acquired infections – Engineering down the risks” which
states the following:

. 3.2(a) Disposal rooms para 2 – “Chutes require particular design
features and will raise ongoing maintenance and cleaning issues. In
addition, chutes can propel airborne contaminants throughout the facility.
Therefore, chutes should not be incorporated in design features for the
management of transport of waste or linen in healthcare facilities”

These standards may be somewhat out of date (i.e. 2003) as new generation
waste and linen chute systems have been introduced into Europe, Asia and the
US for use in residential, industrial, commercial and hospital and nursing
home settings.

In the US the “2010 edition of the FGI “Guidelines for Design and
Construction of Health Care Facilities”, refuse and linen chutes are
permitted and the guideline and states the following:

Refuse chutes

2.1.4 Patient Support Services

2.1-5 General Support Services and Facilities

2.1 – 5.4 Waste Management Facilities

2.1 0 5.4.1.4 Refuse chutes, If provided, these shall meet or exceed the
following standards:

(1) Chutes shall meet the provisions described in NFPA 82

(2) Service openings to chutes shall comply with NFPA 101

(3) Chute discharge into collection rooms shall comply with NFPA 101

(4) The minimum cross-sectional dimension of gravity chutes shall be 2 feet
(60.96 centimetres)

Linen chutes

2.2-5.2.6 – if provided shall meet or exceed the following standards:

2.5 -5.2.6.1 Standards

(1) Service openings to chutes shall comply with NFPA 101

(2) Chutes shall meet the provision described in NFPA 82

(3) Chute discharge into collection rooms shall comply with NFPA 101

2.2-5.2.6.2 Dimensions. The minimum cross-sectional dimensions of gravity
chutes shall be 2 feet

(60.96 centimetres)

The NFPA is the US “National Fire Protection Association”

In addition the USA DRAFT – 2014 edition of the FGI “Guidelines for Design
and Construction of Health Care Facilities” includes guidelines for such
chutes.

The draft 2014 manuscript is available for public comment can be accessed at
the following link: http://www.fgiguidelines.net/comments/draft.php

Regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

H: +61 3 96902216

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

Of Michael Wishart
&/or waste chute

Hi Sony

My understanding is that in Australia, most new hospital buildings, and
indeed those being refurbished, have removed linen and waste chutes due to
fire regulations prohibiting them. So I would not think there are many
hospitals with these kinds of chutes left in this country.

Cheers
Michael Wishart

Michael Wishart

CNC Infection Control

Holy Spirit Northside Private Hospital

627 Rode Road, Chermside, Qld 4032

t: (07) 3326 3068 | f: (07) 3326 3523

e: Michael.Wishart@hsn.org.au

w:
http://www.holyspiritnorthside.org.au

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_____

SO [sony@HA.ORG.HK]

Dear All,

We are preparing our hospital renovation project, hence we would like to
know whether you would use linen chute &/or waste chute.

Your sharing would be a tremendous help.

Regards,

Sony SO

Nursing Officer, Infection Control Team

Kwong Wah Hospital

HONG KONG SAR, CHINA

Tel:+ 852 3517-2409 Fax: +852 2332-3348 email:sony@ha.org.hk

Please consider the environment before printing this e-mail

_____

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[Glenys Harrington]

Hi Michael and members,

While I appreciate the workload issues of the moderator/administrator of the
infexion connection I agree with Cath in that the use of brand names in the
absence of a FDA/TGA/manufacturer alert/recall is inappropriate and
depending on the discussion may also be litigious.

Regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

Of Michael Wishart

Hi Cath

Food safety recommendations preclude use of non-food safe chemicals in the
food processing environment, which precludes use of most alcohol based hand
hygiene products and some antiseptic products. I do believe there are some
waterless hand hygiene products (not sure if some of these should be
considered ‘alcohol’ based, though) that are approved as ‘food safe’, but
most of those alcohol based hand hygiene products routinely in use in
healthcare have not been approved as ‘food safe’. Thus, the use of alcohol
based hand hygiene products within certain parts of food services with
healthcare facilities is problematic, which is why I think this is a good
question, and I believe the responses have indicated this.

In regard to mentioning of brand names, yes, we generally try to recommend
avoiding use of brand names in discussions where possible, but this creates
some work for both myself as the moderator and the list subscribers who are
replying. Rather than bog the list down in administrative emails and such, I
have preferred to weigh up the issue of posting of actual product names with
the benefits of open discussion. For example, in this instance, my belief
was it was useful to see which actual products are being used in what
aspects of food service delivery (eg ward delivery vs food production), as
this was conducive to the conversation. This approach had been supported by
previous ACIPC / AICA executives, although like all things, this is open to
review with further comments from the membership.

It is always useful to examine what we are discussing, how we are discussing
it, and what benefit and risk these discussions may have, so I thank you for
your comments. More discussion is always welcomed!

Cheers

Michael Wishart

Infexion Connexion Administrator

Michael Wishart

CNC Infection Control

Holy Spirit Northside Private Hospital

627 Rode Road, Chermside, Qld 4032

t: (07) 3326 3068 | f: (07) 3607 2226

e: Michael.Wishart@hsn.org.au

w:
http://www.holyspiritnorthside.org.au

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Of Cath Murphy

Hi Marlize

I’m curious about the question and the responses. As I understand it there
have been no scientific reports or official Australian public policy
directives that suggest differentiating between what is available in public
areas, in the wards where staff perform hand hygiene before feeding patients
and/or in kitchens or food prep areas. I checked the WHO Guidelines from
2009 and they also appear to be silent on the issue.

Given that one of the basic tenets to improve hand hygiene compliance is
standardisation I would think it wise if you introduced or continued to use
a neutral liquid soap identical to that used in the settings mentioned
above. The key points are making sure kitchen staff understand the
importance of HH as part of food hygiene, that they perform it when needed
(including when on the ward if potentially exposed) and that their technique
and wearing of gloves is performed in such a way that the skin on their
hands is maintained. It would be an education rather than a product issue I
think.

As always I am surprised to see brand names mentioned here in the forum
given its policies and conditions around promotion etc it would be more
ethical to stick to using generic terms but perhaps the moderator can
advise. Also my experience would indicate that if you raised the issue of HH
for kitchen staff your current supplier of HH product would no doubt be able
to provide you with data and information regarding suitability of their
product in that setting.

Good luck and thanks for making me curious 😉

Cath

Cathryn Murphy PhD

Executive Director

Infection Control Plus Pty Ltd

http://www.infectioncontrolplus.com.au

Description: twitter logo
Description: FB logo
Description: icp icon

Of SAWMH.ICC

Dear All,

We are currently looking for a alcohol based hand sanitiser to use in our
Food Service Department. I was wondering what the practices are out there,
and what product you are using in your Food Service Departments and on your
food delivering trolleys?

Thank you and regards

Marlize Senekal

Infection Prevention and Control Coordinator

St. Andrew’s War Memorial Hospital

457 Wickham Terrace, Spring Hill

Brisbane

Ph. 07-3834 4444

Ext. 4328, Pg. 0328

_________________________________________________________________

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